A group of American and Chinese researchers published data this week showing that artificial intelligence (AI) is as accurate as physicians in diagnosing common clinical conditions in children. Scientists built an AI model using neural networks to process patient history, physical exam and lab data, clinical symptoms and other information to automatically generate a diagnosis. Using that model to evaluate the records of over 600,000 Chinese pediatric patients, the diagnostic accuracy of the AI-driven model was largely equivalent to that of physicians. Looser privacy standards in China make it easier to aggregate the data for AI-driven diagnosis, presenting a potential roadblock for replicating the results in the US. However, researchers cite the potential for AI to complement physician diagnosis, as algorithms recognize patterns that are often missed by doctors.

The scale of this study is impressive, but it’s hardly the first to illustrate the promise of AI in improving diagnosis and even substituting for high-cost clinical labor. However, few AI technologies have been able to make the leap from promising algorithm to real clinical application. Writing in Nature Medicine, digital-medicine guru Dr. Eric Topol recently reviewed the science and application of AI across clinical care, and found that while he “couldn’t find one discipline in medicine that doesn’t have significant AI potential impact”, there is an “AI chasm” between the developing science and real clinical impact. Most AI research is retrospective, and Topol identifies the need for true gold-standard, prospective studies. But he says that real impact, likely in visual diagnosis, could be imminent, with studies demonstrating AI analysis of radiographic images, retinal scans and skin lesions that is equal to or better than a doctor’s read. Topol doesn’t cite one key barrier of AI implementation: professional guilds, who have vested interest in keeping the diagnostic business in the hands of their members. Regardless, AI represents a promising path to reducing reliance on expensive human labor, one that is sure to be adopted as cost pressures mount. While we’d predict the first impact will come from automating “back-office” functions, doctors who resist AI are fighting a losing battle.

Successful physicians will ascertain how to use AI to augment their practice—and the ones who blindly resist its use may be most in danger of being rendered obsolete.

Microsoft announced its new service to help healthcare companies store patient data in the cloud and a Healthcare Bot service that will be integrated with Electronic Health Records.

The tool will be based on Microsoft’s Azure cloud platform, which it describes as a secure end-to-end platform that organizations can use to store and analyze sensitive data.

“Healthcare leaders are thinking about how they bring their data into the cloud while increasing opportunities to use and learn from that data,” Microsoft wrote in a blog.

With its new healthcare push, Microsoft aims to create a system that makes health records more easily accessible and sharable between clinicians, researchers, and patients, Bloomberg reports.The corporation also sees its integrated healthcare storage as a way to attract companies to Microsoft, over its competitor Amazon Web Services.

Both Microsoft and Amazon faced backlash over contracts with Immigration and Customs Enforcement, to provide the agency with cloud storage for biometric information.

Microsoft will not only provide healthcare organizations with an accessible storage and information sharing platform, but the company is also making its healthcare bots available to more healthcare organizations. The Microsoft Healthcare Bot service will include chatbots, and features like medical content and terminology and a built-in symptom tracker, the company announced Thursday.

The bots will also help patients find clinical trials for new drugs and therapies, or answer questions about their prescriptions, according to Bloomberg.

No occupation will be unaffected by the technology, but healthcare will be affected less than other industries, owing much to its inherent complexity

Across the country and across industries, workers are nervous that automation and artificial intelligence will eventually take over their jobs. For some, those fears may be grounded in reality.

Healthcare, however, looks like it will be largely safe from that trend, a new report from the Brookings Metropolitan Policy Program finds.

Examining a chunk of time from the 1980s to 2016, the piece tracks the historical evolution of the technology and uses those findings to project forward to 2030.

The verdict? AI will replace jobs in various industries, but not so much in healthcare.

IMPACT

AI is projected to be an increasingly common form of automation, and the report claims the effects should be manageable in the aggregate labor market. Uncertainty remains, of course, and the effects will vary greatly — across geography, demographics and occupations.

Overall, though, only about 25 percent of U.S. jobs are at a high risk of replacement by automation. That translates to about 36 million jobs, based on 2016 data.

A higher percentage, 36 percent, are at medium risk (52 million jobs) while the largest group is the low-risk group, at 39 percent (57 million jobs).

Most of healthcare belongs in the medium-to-low categories, largely driven by the complexity of healthcare jobs. Still, the risk varies wildly. Medical assistants have what the report calls “automation potential” of 54 percent, but home health aids have just an 8 percent automation potential. Registered nurses sit somewhere in between, at 54 percent.

For healthcare support occupations, the number is closer to 49 percent; healthcare practitioners and technical jobs have 33 percent automation potential.

TREND

The report emphasizes that while some occupations will be safer from automation than others, no industry will be unaffected totally. Mundane tasks will be the most vulnerable.

Fortunately for those in the industry, there’s little in healthcare that’s mundane. AI and machine learning algorithms tend to rely on large quantities of data to be effective, and that data needs human hands to collect it and human eyes to analyze it.

And since AI in healthcare is currently utilized mainly to aggregate and organize data — looking for trends and patterns and making recommendations — a human component is very much needed, an opinion shared by several experts, who point out that empathy are reasoning skills are required in the field.

If you want to understand the shifting sands of healthcare, you’ll find no better place than the nonprofit provider track during the infamous JP Morgan Healthcare Conference that took place this week in San Francisco.

Over 40,000 players were in town from every corner of the healthcare ecosystem. However, if you want to hear the heartbeat of what’s happening at ground level, you needed to literally squeeze into the standing room only nonprofit provider track where the CEOs and CFOs of 25 of the most prominent hospitals and healthcare delivery systems in the country shared their perspectives in rapid-fire 25 minute presentations.

This year those presenters represented over $300 billion, or close to 10 percent of the annual healthcare spend in U.S. healthcare. These organizations play a truly unique role in this country as they are integrated into the very fabric of the communities that they serve and are often the single largest employer in their respective regions. In other words, if you work in or care about healthcare, understanding their perspective is a must.

Every year I take a shot at condensing all of these presentations into a set of takeaways so healthcare providers who aren’t in the room can share something with their teams to help inform their strategy. So what do you need to know? Glad you asked, here you go.

Shift Happens — Moving from Being a Healthcare Provider to Creating a Platform for Health and Healthcare in Your Community

Trying to synthesize 25 presentations into a single punch line is pretty stressful. I listened to every presentation, debriefed with other healthcare providers in the audience afterwards and then spent the next 48 hours trying to process what I heard. I was stumped.

But then, finally, it hit me. To take a new spin on an old phrase, “It’s the platform, stupid.” To be clear, even though I’ve been in healthcare for close to 30 years, “stupid” in that sentence is absolutely referring to me.

So the No. 1 takeaway from the 2019 JP Healthcare Conference is this — for healthcare providers, there is a major shift taking place. They are moving from a traditional strategy of buying and building hospitals and simply providing care into a new and more dynamic strategy that focuses on leveraging the platform they have in place to create more value and growth via new and often more profitable streams of revenue. Simply stated, the healthcare delivery systems of today will increasingly leverage the platform and resources that they have in place to become a hub for both health and healthcare in the future. There is a level of urgency to move quickly. Many feel that if they don’t expand the role that they play in both health and healthcare in their community, someone else will step in.

Folks in tech would think of this as the difference between a “product” strategy (old school) and a “platform” strategy (new school). Think of this as the difference from cell phones (Blackberry) to smartphones (iPhone and Android devices). One was a product, the other was a platform. Common platforms that we’re all familiar with such as Facebook, Amazon, Google, Apple and even Starbucks have always 1) started with a very small niche, 2) built an audience, 3) built trust and 4) then added other offerings on top of that platform. By now there is no need for a “spoiler alert.” We all know that this strategy works and these companies have created a breathtaking amount of value. The comforting news for hospitals and healthcare delivery systems is that many have already completed the first three steps and have many of the building blocks they need to leverage a “platform” as a business strategy. The presentations at the JP Morgan Healthcare Conference made it clear that most are now actually taking that fourth step to separate themselves from the pack.

There is enormous upside to those who understand this pivot and take advantage of this change in the market. Dennis Dahlen, CFO of Mayo Clinic, shared his perspective on this: “Thinking differently in the future is essential. In many ways, at Mayo, we are already operating as a platform today, but we have to continue to leverage this approach to uncover additional ways that we can be a hub for both health and healthcare in our community.” Mayo’s platform includes leveraging research, big data, expert clinic insights and artificial intelligence to create new value for Mayo’s clinical practice as well as new opportunities for Mayo’s partners.

To be clear, the mental shift here is massive. It’s the difference of being on defense (where most healthcare providers are) to be being on offense (which is where they know they need to be). Executive teams have focused their time, energy and resources on driving and supporting inpatient admissions via a traditional bricks and mortar presence coupled with the acquisition of physician practices. The difficulty of thinking through what it means to truly be “asset light” and taking a different approach shouldn’t be underestimated. The good news is that the recent financial results of many health systems have improved, providing a little breathing room for investments to enable this shift in strategy. Those who don’t may fall way behind.

A New Way of Thinking — What it Means to be a Hub

Being a hub is essentially bringing together people with common interests to spark innovation and facilitate work getting done more efficiently. Examples include Silicon Valley as a “tech hub,” Los Angeles as an “entertainment hub,” New York as a “financial hub,” Washington, D.C. as a “hub for politics” and how essentially every college town is or can become a “research hub.”

Given that hospitals and health systems are the largest employers in their community, they are already set up to become a hub. In the past, they leveraged that position to simply care for the sick. Increasingly in the future, these organizations will be health and healthcare hubs for innovation and building new companies, for bringing the community together to tackle issues like hunger and homelessness, for education and training, for research and development partnerships, for coordinated, compassionate and longitudinal care delivery for treatment, for support groups for specific chronic conditions, for digital and virtual care, and for thoughtful and effective support for mental and behavioral health. Changes in the care delivery market over the last 10 years have put the right building blocks in place to make this happen.

Hiding in Plain Sight — The Single Biggest Change in Healthcare We May Ever See Has Already Happened

Taking advantage of becoming a hub and leveraging the strategic concept of being a platform requires new thinking, new structures and new skill sets. The great news for healthcare providers is they have already made the toughest move of all in order to set this in motion.

Over the last decade, there has been a massive level of consolidation with hundreds of hospitals and thousands of physician practices being acquired every year. While more mergers and acquisitions will still happen, this stunning and fundamental restructuring of healthcare delivery has taken place and there is no turning back. This is likely the single biggest shift relative to how healthcare is structured in this country that will take place during our lifetime, and it barely gets mentioned. The strategy many were chasing was primarily being driven by a “heads in beds” pay-off that was both based on offense (“an easier way to grow”) and defense (“we better buy them before someone else does”). That said, as this consolidation happened most healthcare delivery systems were really just an amalgamation of stand-alone hospitals set up as a holding company that provided no real leverage other than more top-line revenue.

During the JP Morgan Healthcare Conference, it was clear that most have made the shift from a holding company into a single operating entity. Chicago-based Northwestern Medicine shared a very refined playbook for quickly bringing acquisitions onto their “platform,” and the results are pretty stunning as they have transformed from a $1 billion academic medical center into a $5 billion regional healthcare hub in a handful of years.

And over the last few years, these organizations have gotten super serious about making the toughest decisions right away. The mega-merger of Advocate Health and Aurora Health, the largest healthcare delivery systems in Illinois and Wisconsin respectively, was accompanied by a gutsy decision to fast-track the implementation of Epic at Advocate to get the leverage of a single EHR platform across the system. While many focus on the cost of the transition and the shortcomings of some of the applications, what gets missed is the enormous long-term leverage this provides regarding communication, integration, continuity of care and, of course, access to data and the potential to improve clinical and financial performance. This creates a “platform-like” experience for both employees and customers.

So, the twist in the story is that the pay-off for consolidation will likely be very different and perhaps much better than many had originally intended. They have the building blocks in place to be a health and healthcare platform for their community. But now they need to figure out how to truly take advantage of it.

During their presentations the 25 non-profit provider organizations opened up their playbooks on how others can leverage their platforms and the idea of becoming the hub for health and healthcare in their respective communities. Here is what they shared.

1. Create the Digital Front Door — or Someone Else Will

The big shift in play right now is the moving away from traditional reliance on transactional face-to-face interactions with individual providers. Building relationships and trust is something that has been a core competency and core strategic asset for hospitals in the past. In the future, this simply won’t be possible without leveraging digital platforms as we do in every other aspect of our lives today. As Stephen Klasko, MD, CEO of Philadelphia-based Jefferson Health, shared, the real strategy will be to deliver “health and healthcare with no address.”

Many provider organizations are moving aggressively to create digital front doors. Kaiser Permanente delivered 77 million virtual visits last year. Intermountain introduced a virtual hospital that provides over 40 services and has delivered over 500,000 interactions. Nearly every health system leverages MyChart or a similar personal health record platform. There is an enormous amount of risk for hospitals and health systems that don’t take action here, as traditional healthcare providers will be competing with more mainstream and polished consumer brands for the relationships and trust of the folks in their community.

As the team from Spectrum Health shared, “87 percent of Americans measure all brands against a select few — think Amazon, Netflix and Starbucks.” Google, Apple and Facebook as well as Walgreens or CVS are all going after this “digital handshake,” and are big threats to healthcare providers. There is no question that some of these organizations will be “frenemies,” where they are both competing and collaborating. Healthcare organizations will need to approach any partnerships mindful of that risk.

2. Drive Affordability and Reduce Cost — or Risk Being the Problem

As the burden of the cost of care increasingly shifts to the patient’s wallet, healthcare providers will need to play in driving affordability. Coupled with the recent federal requirement to post prices online, there is a great deal of visibility around the price of care, even if the numbers are way off the mark. Understanding and reducing the total cost of care is now viewed as a requirement. As legacy cost accounting applications relied on charges as a proxy for cost and were limited to the acute care setting, most provider organizations have or are now in the process of deploying advanced cost accounting applications with time-driven and activity-based costing capabilities including a number that presented during the conference, such as Advocate Aurora Health, Bon Secours Mercy, Boston Children’s Hospital, Hospital for Special Surgery, Intermountain Healthcare, Northwestern Medicine, Novant Health, Spectrum Health and Wellforce.

This was one of the hottest topics during the conference, and there was significant buzz regarding having a single source of truth for the cost of care across the continuum. Vinny Tammaro, CFO of Yale New Haven Health, commented, “We need to align with the evolution of consumerism and help drive affordability in healthcare. How we leverage data is mission critical to making this concept a reality. Bringing clinical and financial data together provides us with a source of truth to help both reduce the cost of care as well as reallocate our finite resources to high impact initiatives in our community.” Organizations like Intermountain Healthcare, which implemented a 2.7 percent price reduction in exchange pricing, are taking the next step in translating cost reduction into lower prices for consumers. And now healthcare systems are starting to work together to create additional leverage via Civica Rx, which now includes 750 hospitals joining forces to help lower the cost of generic drugs.

3. Tackle Social Determinants of Health — or You Won’t Be the Hub for Health in Your Community

It is always less expensive to prevent a problem than it is to fix it. The good news is that the economic incentives for hospitals and healthcare delivery systems to both think and act that way are beginning to line up. They are certainly there already for providers that are also health plans such Intermountain, Kaiser Permanente, Providence St. Joseph Health, Spectrum Health and UPMC. They are also in place for providers that have aggressively taken on population-based risk contracts such as Advocate Aurora Health. With that said, it feels like every health system is starting to lean in here — and they should.

Being the central community hub for these issues makes a ton of sense. The way that Kaiser framed it is that while they have 12 million members, there are 68 million people in the communities they serve. Taking that broader lens both allows them to make a bigger impact but also broaden their market. Many organizations, such as Henry Ford Health System, are taking on hunger via fresh food pharmacies. Geisinger shared how a 2.0 reduction in Hemoglobin A1c reduction leads to a $24,000 cost reduction per participant in their fresh food “farmacy.” So while hospitals are perfectly positioned, have the resources and know it’s the right thing to do, they are now also beginning to understand the business model tied to targeting the social determinants of health. There is also strong strategic rationale associated with taking on a broader role of driving health versus only providing healthcare.

4. Create Partnerships for Healthcare Innovation — or Lose the Upside

Spectrum Health has a $100 million venture fund. Providence St. Joseph’s Health announced a second $150 million venture capital and growth equity fund. Mayo Clinic Ventures has returned over $700 million to their organization. Jefferson Health has a 120-person innovation team focused on digital innovation and the consumer experience, partnering with companies to build solutions. These are all variations on a theme as virtually every organization that presented is leveraging their resources to make a bigger impact and drive additional upside from their platform. “We have close to 900 agreements with over 500 partners,” stated Sanda Fenwick, CEO of Boston Children’s Hospital. “Our strategy is to be a hub for research, innovation and education in order to help evolve how care is delivered. This can only be done by collaborating with others.”

5. Become the Hub for Targeted Services and Chronic Conditions — or They Will Go Elsewhere

Perhaps the best example here is the work of Hospital for Special Surgery, the largest orthopedics shop in the world. It is has become a destination for good reason — fewer complications, fewer infections, a higher discharge rate to home and fewer readmissions. The most compelling data point is that when patients come to HSS for a second opinion, one-third of the time they receive a non-surgical recommendation. The same type of shopping is increasingly going to happen for chronic conditions.

Healthcare delivery systems that take a more holistic yet targeted approach have significant potential. They will need to think more deeply about the end-to-end experience and become immersed within the community outside of the four walls of the hospital. Other players in the community, such as CVS Health and Walgreens, would say they have a platform — and they would be right. The platform that healthcare providers have built and are building will absolutely be competing against other care delivery platforms.

6. Leverage Applied Analytics — or You’ll Lose Your Way

In order to enable everything listed above, the lifeline for every health and healthcare hub will be actionable data. Applied analytics is a boring term that is actually gaining traction and starting to dislodge buzzwords like big data, machine learning and artificial intelligence relative to its importance to healthcare providers.

Similar to how analytics are being used in a practical way in baseball to determine where to throw a pitch to a batter or position players in the field, healthcare providers are pushing for practical data sets presented in a simple, actionable framework. That may seem obvious, but it is simply not present in many healthcare organizations that have been focused on building data warehouse empires without doors to let anyone in. Many organizations, such as Advocate Aurora Health, Bon Secours Mercy and Spectrum Health, have deployed more dynamic business decision support solutions to access better insight into performance and care variation. This allows them to assess opportunities to reallocate resources to invest in more productive ways to leverage their platform.

While leveraging a platform as a business strategy is new to healthcare providers, the good news is that building blocks are already in place. It’s time to leverage that platform to drive better outcomes and more affordable care in the community. And now is the time to get started.

If 2018 was about who was getting jobs, 2019 may be about how jobs work. Indeed, this may be the year that organizations start retooling how they find, evaluate, and even pay employees. Chalk the shifts up to, among several factors, the tight labor market and a massive influx of data, says Jeanne MacDonald, global co-operating executive and president of global talent solutions for Korn Ferry’s RPO and Professional Search business. “To succeed in attracting, developing, and retaining top talent as we head into another year, it’s critical to be agile and forward thinking,” she says.

Korn Ferry canvassed talent acquisition specialists, compensation experts, and HR professionals from around the world to identify 10 emerging talent trends in 2019.

(Don’t) Mind the Gap!

It has always been a red flag—the “hole” in a candidate’s resume, a period of time where a candidate wasn’t working. But an increasing number of organizations are realizing that those holes are there for very legitimate reasons, such as taking time off to care for children or aging loved ones. Many firms are now actively seeking out people with these types of gaps, MacDonald says. Firms are using workshops, customized landing pages and microsites, and other means to find these people.

Making Artificial Intelligence More “Intelligent”

Artificial intelligence (AI) has been touted as the new holy grail in recruiting. However, experts worry that its “intelligence” could create a lack of focus on diversity and inclusion. Even when resumes are anonymized by removing candidate names, AI often can figure out a candidate’s gender by analyzing the phrases used. For instance, “takes charge” and “tough task master” are often associated with men, while “leads persuasively” and “committed to understanding” are often used by women.

One way to help alleviate the issue is to feed the artificial intelligence with non-partial data, such as talent assessment data, that highlights success factors. The AI also needs to be trained to look more for the skills needed for a specific role instead of focusing on subjective modifiers, says George Vollmer, Korn Ferry’s vice president of global account development.

Personalized Pay: Go Ahead, We’re Listening

There are four generations now in the workforce, each with different expectations when it comes to pay and rewards packages. Forward-thinking firms are using social listening, focus groups, and surveys to figure out what each generation actually wants. With that information, they are able to tailor rewards packages, offering different mixes of pay, flextime, paid time off, international assignments, student loan repayment, and other benefits. This is turning the pay and rewards discussion from a company talking to the entire employee population to a one-to-one discussion with employees.

Rethinking the Annual Performance Review

In the United States, the average job tenure is a little more than four years. Experts say that with such short tenures, annual reviews are no longer the primary way to help employees develop professionally. Many employees already recognize this. In a recent Korn Ferry survey of professionals, 30% said their annual review had no impact or was ineffective at improving their performance, and 43% said it had no impact or was unhelpful at making them understand what to do to improve future performance.

Firms are starting to consider real-time feedback as, at a minimum, a supplement to annual reviews, if not a substitute. Ongoing feedback can help employees learn and stay engaged.

Digging Deeper into the Diversity and Inclusion Pipeline

Around the world, there have been growing mandates for more women on boards and other senior leadership positions. While that’s a good development, firms need to maintain focus across all levels of an organization to create an ongoing pipeline of diverse talent, including women, people of color, disabled persons, and LGBTQ employees. To measure their progress, many organizations have begun using applicant tracking systems to find out what percentage of minority applicants were hired.

How Are We Doing?

For years, consumer product companies and retailers have been surveying customers about their experiences with the brand. Increasingly, that practice is becoming part of the recruiting process. Technology is allowing for real-time feedback from candidates about their experiences during the recruiting cycle. The survey tools seek feedback at all points within the process, which gives recruiters and hiring managers data-driven insights and intelligence.

With the data, they can amend recruiting practices, including specific job requirements and interactions with candidates, to successfully hire the best people.

That’s Really a Title?

Chief happiness officer. Data wrangler. Legal ninja. They may sound like off-the-wall job titles, but roles like these are emerging across many industries to meet the changing strategies of organizations.

For example, healthcare, finance, and other firms are increasingly looking to hire a chief experience officer. These businesses realize that the need is stronger than ever for customers to have positive experiences at every touchpoint, MacDonald says. Another emerging C-suite role is chief transformation officer, who is usually tasked with change-management initiatives, often during times of mergers and acquisitions.

Some names are also popping up to attract younger employees. For instance, data wranglers are responsible for organizing and interpreting mounds of data, and legal ninjas are the new generation of legal aides.

Talent Analytics Is Becoming Just as Important as Business Analytics

Traditionally, business leaders set their strategy by analyzing business analytics to determine cost and operational effectiveness. However, experts say they may fail because they don’t find the right type of talent. Increasingly, firms are incorporating talent analytics into the mix. This data measures things such as competition for qualified talent in a region and compensation norms.

Talking Talent Holistically, From Hire to Retire

With the massive influx of data, one would assume organizations would have an integrated way to analyze all elements of talent decisions, including recruiting, compensation, and development. Unfortunately, in many organizations, each of these functions is operating under a different “language,” often unable to talk with one another.

Experts say there is a trend toward a more foundational, data-centric approach that creates insights from organizational, team, and individual perspectives. That allows for a calibrated approach to talent that is tightly linked to business outcomes. For example, the data garnered during the recruitment process can be used to help create a customized development program once the candidate is hired.

Managing Short-Term Hiring Needs with Long-Term Business Goals

The speed of technological advances and changing business priorities makes knowing what’s going to happen next year—or even next month—extremely difficult. In fact, in a recent Korn Ferry survey of talent acquisition professionals, 77% say they are hiring for roles today that didn’t even exist a year ago.

Leading organizations are taking a holistic approach to talent acquisition. In the short term, they are speeding up hiring by figuring out the right mix of short-term contractors, gig workers, and full-time employees to do the work that currently needs to be done. At the same time, they are focusing on a longer-term approach by taking a deep dive into business imperatives to create a total strategic plan that has clearly defined goals, but one that can be amended as needs change.

Vertical integration is all the rage in healthcare these days, with Aetna, Cigna and Humana making notable plays.

If the proposed CVS-Aetna, Cigna-Express Scripts and Humana-Kindred deals are cleared by regulators, the tie-ups will have to immediately face UnitedHealth Group’s Optum, which has been ahead of the curve for years and built out a robust pharmacy benefit manager (PBM) business already along with a care services unit, employing about 30,000 physicians and counting.

UnitedHealth formed Optum by combining existing pharmacy and care delivery services within the company in 2011. Michael Weissel, Group EVP at Optum, told Healthcare Dive the company began by focusing on three core trends in the industry: data analytics, value-based care and consumerism.

Since then, the company has been on an acquisition spree to position itself as a leader in integrated services.

“For the longest time, the market assumed that they were building the Optum business [to spin it out] and what is interesting in the evolution of the industry is that that combination has now set a trend,” Dave Windley, managing director at Jefferies, told Healthcare Dive.

“United has now set the industry standard or trend … to be more vertically integrated and it seems less likely now that United would spin this out … because many of their competitors are now mimicking their strategy by trying to buy into some of the same capabilities,” he said.

Weissel said Optum will continue to push on the three identified trends in the next three to five years, with plans to invest heavily in machine learning, AI and natural language processing.

The question will be whether and how the company can keep its edge.

What Optum is

Optum is a company within UnitedHealth Group, a parent of UnitedHealthcare. Optum’s sister company UnitedHealthcare is perhaps more well known within the industry and with consumers.

However, Optum, a venture that encompasses data analytics, a PBM and doctors,has been gradually building its clout at UnitedHealth Group.

In 2017, the unit accounted for 44% of UnitedHealth Group’s profits.

In 2011, UnitedHealth Group brought together three existing service lines under one master brand. Services are delivered through three main businesses within a business within a business:

OptumHealth – the care delivery and ambulatory care capabilities of OptumCare, as well as the care management, behavioral health, and consumer offerings of Optum;

The Eden Prairie, MN-headquartered company has recently expanded its care delivery services, with much of the growth coming from acquisitions. The past two years have seen Optum expand its footprint into surgical care (Surgical Care Affiliates), urgent care (MedExpress) and primary care (DaVita Medical Group).

It’s a wide pool, but the strategy affords UnitedHealth the opportunity to grab more revenue by expanding its market presence. For example, the DaVita acquisition, which is still pending, allows OptumCare to operate in 35 of 75 local care delivery markets the company has targeted for development, Andrew Hayek, OptumHealth CEO, said on an earnings call in January.

Optum’s strategy of meeting patients where they are and deploying more ambulatory, preventative care services works in concert with its sister company UnitedHealthcare’s goal of reducing high-cost, unnecessary care services, when applicable. If Optum succeeds in creating healthier populations that use lower levels of care more often, that benefits the parent company UnitedHealth Group as UnitedHealthcare spends less money and time on claims processing/payout.

The strategy has been paying off so far.

Three charts that show UnitedHealth’s financial health as it relates to Optum

Optum’s presence has grown as it has steadily increased its percentage of profits for UnitedHealth Group.

Credit: Healthcare Dive / Jeff Byers

In 2011, the first year Optum was configured as it looks today, the company contributed 14.8% of total earnings through operations to UnitedHealth Group with $1.26 billion. That’s about 29 percentage points lower than in 2017, when Optum brought in $6.7 billion in profits on $83.6 billion in revenue.

Broken down, it’s clear that pharmacy services make up the lion’s share of the company’s revenue. In 2017, OptumRx earned $63.8 billion in revenue, fulfilling 1.3 billion prescriptions. OptumRx’s contributions to the company took off in 2015 when Optum acquired pharmacy benefit manager Catamaran.

Credit: Healthcare Dive / Jeff Byers

In recent years, OptumHealth has grown due to expansion in care delivery services, including consumer engagement and behavioral and population health management. The care delivery arm served 91 million people last year, up from 60 million in 2011.

OptumInsight has grown largely due to an increase in revenue cycle management and operations services in recent years.

On Wall Street, UnitedHealth Group is performing well and has seen healthy growth since 2008. The stock peaked in January and took a dive when Amazon, J.P. Morgan and Berkshire Hathaway — industry outsiders yet financial giants — announced they would create a healthcare company.

Credit: Healthcare Dive / Jeff Byers

While these charts suggest a dominant force, the stock activity shows that investors believe there’s still more room for competition, if the new entrants play their cards right.

Where Optum could lock out and rivals could cut in on competition

UnitedHealth started down this strategic path many years ago and the rest of the industry just now seems to be catching up.

“Optum’s been the leader in showing how a managed care organization with an ambulatory care delivery platform and a pharmacy benefit manager all in house can lower or maintain and bend cost trend and then drive better market share gains in their health insurance business,” Ana Gupte, managing director of healthcare services at Leerink, told Healthcare Dive. “I think they have been the impetus in the large space for the Aetna-CVS deal.”

Because the company is multi-dimensional, Optum’s competition will be varied. If all the mergers making news — including the Walmart’s rumored buyout of Humana — close, here’s what competition could look like:

Perhaps oddly, its largest revenue contributor, OptumRx, seems to have the largest vulnerability for competition in the coming years.

Optum’s competitive advantage in the PBM space is driven largely by already realized integration. Merging data across IT systems is no easy task, and Optum has spent years harmonizing pharmacy data across platforms to assist care managers in OptumCare to see medical records for United members.

Anyone with experience implementing EHR systems can tell you such integration doesn’t happen over night.

If the Cigna-Express Scripts deal closes, the equity can compete with OptumRx, but the technology investment needed to harmonize data and embed Cigna’s service and pharmacy information into Express Scripts servers will take time, Windley said. Optum, on the other hand, has invested in the effort and integration for years.

Gupte says the encroaching organizations in the PBM space have the ability to realize the efficiencies and savings and the integrated medical that Optum has been realizing across OptumRx and the managed care organization.

Optum’s leg up in PBM space could last two to three years over the competition, she said.

On the care delivery side, OptumHealth has been purchasing large physician groups for a variety of services. There are only so many large physician groups putting themselves on the market, and Optum has been making bids for them.

There’s still a bit of white space to fill in its 75 target markets, but analysts note Optum may have the competition on lock in this space

Even if CVS-Aetna closes, OptumCare is a $12 billion business with many urgent and surgery care access points. If CVS-Aetna is finalized, the company will have about 1,100 MinuteClinics capable of realizing efficiencies with Aetna, but, as Windley notes, they likely won’t have primary care or surgery care elements.

There’s also a lot of time and capital needed for building out and retrofitting retail space to medical areas.

On the surgical care services, “I don’t see either Cigna, Aetna or Humana getting into that business,” Gupte said. “That will be one element of their footprint on care delivery that will be unique and differentiated for them.”

Urgent care has the potential for outsider competition, she added. However, Optum is using its MedExpress business to treat higher acuity conditions and have an ER doctor on staff in each center. Compared to the typical types of conditions treated in retail clinics or those that would be feasible over time, Gupte believes services that could be seen in CVS or Walmart would be lower acuity, chronic care management services.

“[Optum has] been so proactive and so strategic I don’t think there’s going to be a lot of reactive catchup they have to do,” Gupte said. “I think it’s going to be hard for the other entities to play catch up, outside of the PBM.”

One potential issue will be harmonizing the disparate businesses so patients can be effectively managed across the various organizations, Trevor Price, founder and CEO of Oxean Partners, told Healthcare Dive.

“I think the biggest challenge for Optum is operationalizing the combined platform,” Price said. “The biggest question is do they continue to operate as individual businesses or do they merge into one.”

What’s next?

Optum will continue to explore ground in the three core trends it has identified.

Out of the three, consumerism has the longest path to maturity in healthcare, Weissel said, adding he believes consumerism is going to change healthcare more than any other trend over the next decade.

“There is a wave coming, and this expectation that we will move there,” he said. “Increasingly, this aging of people who become very comfortable in a different modality is going to tip the balance with how people will want to interact with healthcare. I know there’s pent up demand already.”

That means the company is putting bets into the marketplace around consumer building and segmentation models as well as thinking about how to connect data to allow patients to schedule appointments, view health records, sign up for insurance, search for providers or renew prescriptions online.

Consumer-centric projects currently underway include digital weight loss programs — including streaming fitness classes — and maternity programs to track pregnancy. The company is also experimenting with remote patient monitoring to understand the impacts on those with heart disease or asthma and to search for service opportunities.

Optum will pursue investments as well as acquisitions to push into the consumer space.

“When it comes to acquisitions to Optum overall, we’re always in the marketplace looking to extend our capabilities, to extend our reach in the care management space to fill in holes or gaps that we have,” Weissel said. “That’s a constant process in our enterprise.”

“In my whole life, I have known no wise people (over a broad subject matter area) who didn’t read all the time — none. Zero.”
— Charlie Munger, Self-made billionaire & Warren Buffett’s longtime business partner

Why did the busiest person in the world, former president Barack Obama, read an hour a day while in office?

Why has the best investor in history, Warren Buffett, invested 80% of his time in reading and thinking throughout his career?

Why has the world’s richest person, Bill Gates, read a book a week during his career? And why has he taken a yearly two-week reading vacation throughout his entire career?

Why do the world’s smartest and busiest people find one hour a day for deliberate learning (the 5-hour rule), while others make excuses about how busy they are?

What do they see that others don’t?

The answer is simple: Learning is the single best investment of our time that we can make. Or as Benjamin Franklin said, “An investment in knowledge pays the best interest.”

This insight is fundamental to succeeding in our knowledge economy, yet few people realize it. Luckily, once you do understand the value of knowledge, it’s simple to get more of it. Just dedicate yourself to constant learning.

Knowledge is the new money

We spend our lives collecting, spending, lusting after, and worrying about money — in fact, when we say we “don’t have time” to learn something new, it’s usually because we are feverishly devoting our time to earning money, but something is happening right now that’s changing the relationship between money and knowledge.

We are at the beginning of a period of what renowned futurist Peter Diamandis calls rapid demonetization, in which technology is rendering previously expensive products or services much cheaper — or even free.

This chart from Diamandis’ book Abundance shows how we’ve demonetized $900,000 worth of products and services you might have purchased between 1969 and 1989.

This demonetization will accelerate in the future. Automated vehicle fleets will eliminate one of our biggest purchases: a car. Virtual reality will make expensive experiences, such as going to a concert or playing golf, instantly available at much lower cost. While the difference between reality and virtual reality is almost incomparable at the moment, the rate of improvement of VR is exponential.

Finally, new devices and technologies, such as CRISPR, the XPrize Tricorder, better diagnostics via artificial intelligence, and reduced cost of genomic sequencing will revolutionize the healthcare system. These technologies and other ones like them will dramatically lower the average cost of healthcare by focusing on prevention rather than cure and management.

While goods and services are becoming demonetized, knowledge is becoming increasingly valuable.

“The central event of the twentieth century is the overthrow of matter. In technology, economics, and the politics of nations, wealth in the form of physical resources is steadily declining in value and significance. The powers of mind are everywhere ascendant over the brute force of things.” —George Gilder (technology thinker)

Perhaps the best example of the rising value of certain forms of knowledge is the self-driving car industry. Sebastian Thrun, founder of Google X and Google’s self-driving car team, gives the example of Uber paying $700 million for Otto, a six-month-old company with 70 employees, and of GM spending $1 billion on their acquisition of Cruise. He concludes that in this industry, “The going rate for talent these days is $10 million.”

Those who work really hard throughout their career but don’t take time out of their schedule to constantly learn will be the new “at-risk” group. They risk remaining stuck on the bottom rung of global competition, and they risk losing their jobs to automation, just as blue-collar workers did between 2000 and 2010 when robots replaced 85 percent of manufacturing jobs.

Why?

People at the bottom of the economic ladder are being squeezed more and compensated less, while those at the top have more opportunities and are paid more than ever before. The irony is that the problem isn’t a lack of jobs. Rather, it’s a lack of people with the right skills and knowledge to fill the jobs.

An Atlantic article captures the paradox: “Employers across industries and regions have complained for years about a lack of skilled workers, and their complaints are borne out in U.S. employment data. In July [2015], the number of job postings reached its highest level ever, at 5.8 million, and the unemployment rate was comfortably below the post-World War II average. But, at the same time, over 17 million Americans are either unemployed, not working but interested in finding work, or doing part-time work but aspiring to full-time work.”

In short, we can see how at a fundamental level knowledge is gradually becoming its own important and unique form of currency. In other words, knowledge is the new money. Similar to money, knowledge often serves as a medium of exchange and store of value.

But, unlike money, when you use knowledge or give it away, you don’t lose it. In fact, it’s the opposite. The more you give away knowledge, the more you:

Remember it

Understand it

Connect it to other ideas in your head

Build your identity as a role model for that knowledge

Transferring knowledge anywhere in the world is free and instant. Its value compounds over time faster than money. It can be converted into many things, including things that money can’t buy, such as authentic relationships and high levels of subjective well-being. It helps you accomplish your goals faster and better. It’s fun to acquire. It makes your brain work better. It expands your vocabulary, making you a better communicator. It helps you think bigger and beyond your circumstances. It connects you to communities of people you didn’t even know existed. It puts your life in perspective by essentially helping you live many lives in one life through other people’s experiences and wisdom.

Former President Obama perfectly explains why he was so committed to reading during his Presidency in a recent New York Times interview:

“At a time when events move so quickly and so much information is transmitted,” he said, reading gave him the ability to occasionally “slow down and get perspective” and “the ability to get in somebody else’s shoes.” These two things, he added, “have been invaluable to me. Whether they’ve made me a better president I can’t say. But what I can say is that they have allowed me to sort of maintain my balance during the course of eight years, because this is a place that comes at you hard and fast and doesn’t let up.”

6 essentials skills to master the new knowledge economy

“The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.” — Alvin Toffler

So, how do we learn the right knowledge and have it pay off for us? The six points below serve as a framework to help you begin to answer this question. I also created an in-depth webinar on Learning How To Learn that you can watch for free.

Identify valuable knowledge at the right time. The value of knowledge isn’t static. It changes as a function of how valuable other people consider it and how rare it is. As new technologies mature and reshape industries, there is often a deficit of people with the needed skills, which creates the potential for high compensation. Because of the high compensation, more people are quickly trained, and the average compensation decreases.

Learn and master that knowledge quickly. Opportunity windows are temporary in nature. Individuals must take advantage of them when they see them. This means being able to learn new skills quickly. After reading thousands of books, I’ve found that understanding and using mental models is one of the most universal skills that EVERYONE should learn. It provides a strong foundation of knowledge that applies across every field. So when you jump into a new field, you have preexisting knowledge you can use to learn faster.

Communicate the value of your skills to others. People with the same skills can command wildly different salaries and fees based on how well they’re able to communicate and persuade others. This ability convinces others that the skills you have are valuable is a “multiplier skill.” Many people spend years mastering an underlying technical skill and virtually no time mastering this multiplier skill.

Convert knowledge into money and results. There are many ways to transform knowledge into value in your life. A few examples include finding and getting a job that pays well, getting a raise, building a successful business, selling your knowledge as a consultant, and building your reputation by becoming a thought leader.

Learn how to financially invest in learning to get the highest return. Each of us needs to find the right “portfolio” of books, online courses, and certificate/degree programs to help us achieve our goals within our budget. To get the right portfolio, we need to apply financial terms — such as return on investment, risk management, hurdle rate, hedging, and diversification — to our thinking on knowledge investment.

Master the skill of learning how to learn. Doing so exponentially increases the value of every hour we devote to learning (our learning rate). Our learning rate determines how quickly our knowledge compounds over time. Consider someone who reads and retains one book a week versus someone who takes 10 days to read a book. Over the course of a year, a 30% difference compounds to one person reading 85 more books.

To shift our focus from being overly obsessed with money to a more savvy and realistic quest for knowledge, we need to stop thinking that we only acquire knowledge from 5 to 22 years old, and that then we can get a job and mentally coast through the rest of our lives if we work hard. To survive and thrive in this new era, we must constantly learn.

Working hard is the industrial era approach to getting ahead. Learning hard is the knowledge economy equivalent.

Just as we have minimum recommended dosages of vitamins, steps per day, and minutes of aerobic exercise for maintaining physical health, we need to be rigorous about the minimum dose of deliberate learning that will maintain our economic health. The long-term effects of intellectual complacency are just as insidious as the long-term effects of not exercising, eating well, or sleeping enough. Not learning at least 5 hours per week (the 5-hour rule) is the smoking of the 21st century and this article is the warning label.

Don’t be lazy. Don’t make excuses. Just get it done.

“Live as if you were to die tomorrow. Learn as if you were to live forever.” — Mahatma Gandhi

Before his daughter was born, successful entrepreneur Ben Clarke focused on deliberate learning every day from 6:45 a.m. to 8:30 a.m. for five years (2,000+ hours), but when his daughter was born, he decided to replace his learning time with daddy-daughter time. This is the point at which most people would give up on their learning ritual.

Instead of doing that, Ben decided to change his daily work schedule. He shortened the number of hours he worked on his to do list in order to make room for his learning ritual. Keep in mind that Ben oversees 200+ employees at his company, The Shipyard, and is always busy. In his words, “By working less and learning more, I might seem to get less done in a day, but I get dramatically more done in my year and in my career.” This wasn’t an easy decision by any means, but it reflects the type of difficult decisions that we all need to start making. Even if you’re just an entry-level employee, there’s no excuse. You can find mini learning periods during your downtimes (commutes, lunch breaks, slow times). Even 15 minutes per day will add up to nearly 100 hours over a year. Time and energy should not be excuses. Rather, they are difficult, but overcomable challenges. By being one of the few people who rises to this challenge, you reap that much more in reward.

We often believe we can’t afford the time it takes, but the opposite is true: None of us can afford not to learn.

Learning is no longer a luxury; it’s a necessity.

Start your learning ritual today with these three steps

The busiest, most successful people in the world find at least an hour to learn EVERY DAY. So can you!

Just three steps are needed to create your own learning ritual:

Find the time for reading and learning even if you are really busy and overwhelmed.

Stay consistent on using that “found” time without procrastinating or falling prey to distraction.

Increase the results you receive from each hour of learning by using proven hacks that help you remember and apply what you learn.

Over the last three years, I’ve researched how top performers find the time, stay consistent, and get more results. There was too much information for one article, so I spent dozens of hours and created a free masterclass to help you master your learning ritual too!